1. Definition

Diabetes Mellitus is a chronic metabolic disorder characterized by high blood glucose (hyperglycemia) due to defects in insulin secretion, insulin action, or both.


2. Types of Diabetes

Type Description Prevalence
Type 1 Autoimmune destruction of pancreatic beta cells; absolute insulin deficiency ~5-10%
Type 2 Insulin resistance and relative insulin deficiency ~90%
Gestational Diabetes diagnosed during pregnancy Varies
Others MODY, LADA, secondary diabetes (e.g., pancreatitis) Rare

3. Historical Context

  • Ancient Egypt (1550 BCE): First descriptions of β€œtoo great emptying of the urine.”
  • Aretaeus of Cappadocia (2nd century CE): Coined the term β€œdiabetes.”
  • Frederick Banting & Charles Best (1921): Discovered insulin, revolutionizing treatment.
  • Recent Advances (2000s-present): Continuous glucose monitoring, artificial pancreas, and stem cell research.

4. Pathophysiology

Type 1 Diabetes

  • Autoimmune attack on beta cells in the islets of Langerhans (pancreas).
  • Absolute insulin deficiency leads to increased blood glucose.

Type 2 Diabetes

  • Insulin resistance in muscle, fat, and liver cells.
  • Beta-cell dysfunction over time.
  • Associated with obesity, genetics, and lifestyle factors.

Diagram: Insulin Pathway

Insulin Pathway


5. Diagnosis

  • Fasting Plasma Glucose (FPG): β‰₯ 126 mg/dL
  • Oral Glucose Tolerance Test (OGTT): β‰₯ 200 mg/dL after 2 hours
  • Hemoglobin A1c: β‰₯ 6.5%
  • Random Plasma Glucose: β‰₯ 200 mg/dL with symptoms

6. Complications

Acute Chronic
Diabetic ketoacidosis (DKA) Cardiovascular disease
Hyperosmolar hyperglycemic state (HHS) Neuropathy
Hypoglycemia Nephropathy
Retinopathy
Peripheral vascular disease

7. Management Strategies

  • Lifestyle modification: Diet, exercise, weight control
  • Pharmacological: Insulin, oral hypoglycemics (metformin, SGLT2 inhibitors, GLP-1 agonists)
  • Technological: Insulin pumps, continuous glucose monitors (CGMs), artificial pancreas systems

8. Recent Research

Citation:
Buse, J.B., et al. (2021). β€œOnce-Weekly Semaglutide in Adolescents with Type 2 Diabetes.” New England Journal of Medicine, 385(7), 637-646.
Read the study

  • Summary: Once-weekly semaglutide significantly improved glycemic control and reduced body weight in adolescents with type 2 diabetes, pointing to new management possibilities.

9. Surprising Facts

  1. Diabetes can affect the brain: Chronic hyperglycemia is linked to cognitive decline and increased risk of dementia, even in younger patients.
  2. Remission is possible: Recent studies show that intensive lifestyle intervention or bariatric surgery can induce remission in some type 2 diabetes cases.
  3. Gut microbiome role: Emerging evidence suggests that gut bacteria composition influences insulin sensitivity and diabetes risk.

10. Impact on Daily Life

  • Dietary choices: Constant monitoring and adjustment of carbohydrate intake.
  • Physical activity: Regular exercise improves insulin sensitivity.
  • Mental health: Increased risk of depression and anxiety due to disease burden.
  • Technology use: Devices like CGMs and insulin pumps are now routine for many patients.

11. Diagram: Diabetes Management Technologies

Diabetes Technology


12. Quantum Computing Analogy

  • Quantum computers use qubits, which can be both 0 and 1 at the same time.
  • Diabetes science increasingly leverages big data and AI: Quantum computing may accelerate analysis of complex genetic and metabolic data, potentially leading to personalized treatments.

13. Further Reading

  • American Diabetes Association (ADA): Diabetes Journals
  • International Diabetes Federation: IDF Resources
  • Recent Review:
    • Advances in Diabetes Technology: Insulin Delivery Devices and Glucose Monitoring Systems (Diabetes Technology & Therapeutics, 2022)

14. Summary Table

Aspect Type 1 Diabetes Type 2 Diabetes
Onset Usually <30 years Usually >40 years
Insulin Requirement Always Sometimes
Pathogenesis Autoimmune Insulin resistance
Remission Possible No Sometimes

15. Key Takeaways

  • Diabetes is a complex, multifactorial disease with evolving management strategies.
  • Advances in technology and research are rapidly changing the landscape.
  • Daily life is profoundly affected, but new therapies and devices are improving outcomes.

End of Notes